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Recommendations for Aromatase inhibitors as adjuvant endocrine therapy

Statements of evidence

STATEMENTS LEVEL OF EVIDENCE TRIAL AND REFERENCE
(see Table 1 for details)
In post-menopausal women with hormone receptor-positive early breast cancer:
Starting adjuvant endocrine therapy with an aromatase inhibitor leads to fewer breast cancerrecurrences than starting with tamoxifen II ATAC2; BIG 1-983
Switching to an aromatase inhibitor after 2–3 years of tamoxifen for a total of 5 years leads to fewer breast cancer recurrences than continuing with tamoxifen for 5 years II IES4; ITA5; ABCSG/ARNO6
Extending treatment with letrozole for 5 years leads to fewer breast cancer recurrences than observation without further treatment in women who have recently completed 5 years of adjuvant tamoxifen II MA.177
Treatment with an aromatase inhibitor leads to fewer contralateral breast cancers than treatment with tamoxifen or placebo II ATAC2; BIG 1-983; IES4; ITA5; ABCSG/ARNO6; MA.177
Arthralgia, loss of bone mineral density and fractures occur more frequently with aromatase inhibitors than with tamoxifen or placebo II ATAC2; BIG 1-983; IES4; MA.177
Venous thromboembolic events and endometrial cancer occur less frequently with aromatase inhibitors than with tamoxifen II ATAC2; BIG 1-983
Hot flushes, vaginal discharge and bleeding may occur less frequently and sexual dysfunction may occur more frequently with aromatase inhibitors than with tamoxifen II ATAC2; MA.177
The effects of aromatase inhibitors (compared with tamoxifen or placebo) on the risks of myocardial infarction and stroke are unclear and require results from trials with longer follow-up II ATAC2; BIG 1-983; IES4; MA.177

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